Who will care for the elderly?

Who will take care of Mom and Dad, and Auntie and Uncle? Nobody wants to talk about this and yet sooner or later nearly all of us are confronted with these difficult decisions. Most people want to put it off hoping it won’t have to be dealt with at all. Some are lucky and the beloved elderly family members live long, healthy lives and have peaceful uneventful passing. But for many, this is not the case and by the time the situation is at hand, most people are unaware of what the wishes are of their elderly relatives, nor have they discussed it with their siblings or spouse. Often we don’t even ask ourselves questions. What am I prepared to do to take care of someone? Can I carry them? Will I change their diapers? And how far do I want my loved ones to go to take care of me? Some advanced planning and discussion could ease this transition.

Total fertility rate (TFR) has declined over the past several decades in most countries across the board, including China and some southern, coastal regions of India. The force behind this decline is lead by the rise in the education of women. The more women are educated the fewer children they tend to have. This simple math equates to fewer people and specifically fewer women to care for grandma and grandpa. This topic is very difficult to approach. Siblings often have a hard time deciding who is to take what responsibility. Adult children have difficulties approaching aging parents on the topic and aging parents struggle to ask for help after decades of self-sufficiency.

The rise in nucleus families (two parents, one or two children) has contributed to decrease in the number of multi-generational families, almost to extinction in some western countries. Many families resort to elderly facilities or senior communities to continue care for their aging relatives. This is often due to more women in the workforce (fewer hands to take care of grandma and grandpa) and increasingly fewer siblings to share the additional activities involved in taking care of aging relatives.

Japan has the steepest declining TFR, the highest percentage of women in the thirties being single, a high percentage of childless woman and women who never marry. This trend is being noted in almost all developing countries. The upside, one might think, is that these women, free of the burden of children or husbands might be more able to care for the elderly. However, most of these women are educated free thinkers and may not want to be chosen just by default or may not want the responsibility at all. The other long-term concern is who will care for these women.

The number of nucleus families in Japan has increased largely due to urbanization while the number of multi-generational families has declined. Many elderly couples and singles live alone. With a growing aging population and social security programs unable to keep up with the demand, more seniors will be unable to move to expensive care facilities or take care of themselves. Traditionally, the eldest son was branded with the responsibility to move in with the parents in their later years and typically in return, they would inherit the family home. Personal preference aside, the number of adult children willing and able to take on this stage is shrinking.

Aunt Maiko, Mana (3), Akari (mother)

Take my husbands family. Obachan is one of nine sisters. While not the eldest, she inherited the family home. She had four sons who all went on to have two children each and live a nucleus family life style. All eight of those grandchildren are mid- to late twenties and so far there is one great-grandchild. There are similar statistics on my side of the family, with each generation having more women with higher levels of education and fewer children.

Recently, Toshiaki’s brothers and wives had a series of “discussions” about what to do regarding impending conditions with Ojiichan and Obaachan. In their case, the eldest brother has not followed tradition and lives separately in another city. Concerns for safety, day to day chores, as well as decisions on health issues, medicines, and finances will need to be made and everyone wants to find the best living arrangements for all involved. Many families deal with these same concerns in addition to plans for inheritance or the other end of the spectrum; families that will have no inheritance and only continued liabilities. Since people are living longer more funds are needed then originally budgeted decades earlier. Medical advantages that sustain life, is also a consideration. While no one wants to die, at what cost, emotionally, spiritually and financially do families persist in order to sustain life, sometimes beyond natural death? I warned you. These are tough issues. Someone will need to be in charge and the responsibilities will be best shared. At some point communication is needed.

I must clarify that while I am presenting statistics and real-life conditions, most people I know, consider it a privilege and would have it no other way then to take care of their parent or loved one. I know that is the case with both my husband’s siblings and mine. However, this is not always the case and with the ensuing demographic changes, a little anticipated thinking may be necessary.

It all can sound pretty grim but there is an upside. There are many actions that can help ease or alleviate some of these challenges. First, an obvious one is better financial planning by all generations. The calculations that worked for our parent’s generation will not be sufficient for upcoming generations. More preparedness leads to less stress.

A second positive response can be an increase or return to multi-generational households and all the cultural benefits of extended family living. This could also mean families sharing their home, time and resources with other solo aging relatives who may not have off springs to care for them, such as aunts and uncles. While not for everyone, many previous generations have experienced support and stronger family bonds in multi-generational homes.

Finally, the low hanging fruit of all around improved family health should be considered. Healthier families live happier lives and have more energy and positive perspective to help each other. As times are changing, open communication, better financial planning and healthier life styles can contribute to more ease in taking care of grandma and grandpa.

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Comments

This is a very thoughtful post on a topic that is dismissed or ignored all too often. It is difficult for many to discuss some of these issues, but I think it has as much to do with conditioning more than anything else. Life is perfect in it’s messy-ness. By that I mean that we tend to avoid issues of aging, illness and death rather than embracing the natural transition of all living things and celebrating change appropriately. The challenges are real and the best way to deal with them is through honest, open and loving conversation. Thank you for sharing your family’s personal experiences and for shining more light on the issue. May you live long and prosper!